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1 STUDENT INSTRUCTIONS FOR VALENCIA COLLEGE - RADIOGRAPHY About CertifiedProfile.com CertifiedProfile is a secure platform that allows you to order your background check online. Once you have placed your order, you may use your login to access additional features of CertifiedProfile, including document storage, portfolio builders and reference tools. CertifiedProfile also allows you to upload any additional documents required by your school. Order Summary Personal Information - In addition to entering your full name and date of birth, you will be asked for your Social Security Number, current address, phone number and address. Drug Test (LabCorp) - Within hours after you place your order, the electronic chain of custody form (echain) will be placed directly into your CertifiedProfile account. This echain will explain where you need to go to complete your drug test. Immunizations - Document trackers provide secure online storage for all of your important documents. At the end of the online order process you will be prompted to upload specific documents required by your school for immunization, medical or certification records. Fingerprints - The online order process will guide you through the steps to complete a statewide Live Scan Fingerprint with FDLE. Payment Information - At the end of the online order process, you will be prompted to enter your Visa or Mastercard information. Money orders are also accepted but will result in a $10 fee and an additional turn-around-time. Place Your Order Go to: Step #1 : Enter package code VA43 to set up your CertifiedProfile account and order your Background Check, Drug Test, and Fingerprints View Your Results Step #2 : Enter package code designated for your program Document Tracker: VA43as for Radiography: Due April 19, 2013 VA43bs for Radiologic Sciences: Due April 19, 2013 Your results will be posted directly to your CertifiedProfile account. You will be notified if there is any missing information needed in order to process your order. Although 95% of background check results are completed within 3-5 business days, some results may take longer. Your order will show as In Process until it has been completed in its entirety. Your school's administrator can also securely view your results online with their unique username and password. Your fingerprint results are sent directly to the school from the FDLE and are not viewable online.

2 Immunization Requirements Measles (Rubeola) -If you were born before 1956 you are exempt from this requirement. -If you were born after 1956 there must be documentation of one of the following: 2 vaccinations Positive antibody titer for Measles (Rubeola) Rubella -If you were born before 1956 you are exempt from this requirement. -If you were born after 1956 there must be documentation of one of the following: 1 vaccination Positive antibody titer for Rubella Varicella (Chicken Pox) -There must be documentation of one of the following: 2 vaccinations Positive antibody titer Medically documented history of disease Hepatitis B -There must be documentation of one of the following: 3 vaccinations Positive antibody titer Declination waiver TB Skin Test -There must be documentation of one of the following: 1 step TB Skin test Quantiferon Gold Blood test If positive results, provide a clear Chest X-Ray Tetanus & Diphtheria (Td) -Documentation of a Td booster within the past 10 years. CDC (2009) recommends at least one dose of Tdap (which includes pertussis), also good for 10 years. CPR Certification -Must be the American Heart Association Healthcare Provider course. Copy must be front and back of the card. Certificates or letters from provider are accepted temporarily until card arrives with a renewal date of 30 days. Physical Examination -Provide your physical exam form completed and signed by a medical professional. N95 Fit Test -Submit your certification indicating size, manufacturer and date. I NEED HELP!!! If you need assistance please contact CertifiedProfile at or and a Student Support Representative will be available Monday-Thursday 8am-8pm, Friday 8am-6pm & Sunday 12pm-8pm EST.

3 Background Check and Drug Screening Guidelines For Valencia Allied Health and Nursing Programs Valencia does not have an official policy regarding student background checks or drug screening. However, all students entering the Nursing and Allied Health programs are required to submit to a criminal background check and drug testing because these programs include clinical rotations in a variety of external affiliate health care facilities, which have policies that we must respect pursuant to our contracts with them. Our affiliates policies require that students serving in a clinical rotation be free of specific offenses that would disqualify them for a student clinical and have their civil rights intact. In addition, our affiliates require that students return negative drug screening results based on a list of specified substances. These guidelines are derived from the requirements specified by our affiliates, and are subject to change upon any modification to our affiliates policies. PROCEDURES: Our affiliates require Level 1 and 2 criminal background checks and 10-panel drug testing of all students. This screening must be completed utilizing the Allied Health and Nursing Divisions process, including use of its designated vendor(s). The results of background checks and drug testing from other facilities or entities will not be acceptable for admission to Valencia s Allied Health and Nursing programs. The clinical portions of the programs are required for program completion and students cannot fulfill the program requirements if they cannot participate in the clinical experience. Incoming students: Background Checks Valencia s healthcare affiliates require Level 1 criminal background checks for all students who participate in clinical experiences in their facilities. The Agency for Healthcare Administration, which governs our affiliates, requires Level 2 background checks/ FDLE finger printing for students whose clinical program places them with vulnerable populations. Valencia s health care affiliates have provided the administration with a comprehensive list of offenses that they deem unacceptable for students entering their facilities. This list is compiled solely by the affiliate, without any input from Valencia. When Valencia receives the results of each background check, those results are compared with the list provided by the affiliate to determine if a listed offense has been discovered. Valencia does not make any determination of the suitability of a student to serve in a clinical rotation or subjectively interpret any results; it merely determines whether an offense listed on a background check report is present on the affiliate s list of unacceptable offenses and advise the affiliate of that fact. The student may meet with the appropriate Academic Dean for consultation regarding the results of background checks; however, the Dean will advise the student only based upon clearly defined offenses provided by the affiliates. The Dean does reserve the right to consider the student for program entry at a later date; if the disposition of an offense is changed in the student s favor; he/shall may be reconsidered for entry to a program.

4 Background Check and Drug Screening Guidelines For Valencia Allied Health and Nursing Programs Drug Testing 10 panel drug testing must be negative for all substances. Dilute negative specimens will not require retesting, unless required by specific health care agency. Valencia s health care affiliates have provided the college administration with a comprehensive list of substances that they deem unacceptable for students entering their facilities. This list is compiled solely by the affiliate, without any input from Valencia. When Valencia receives the results of each drug screening, those results are compared with the list provided by the affiliate to determine if the presence of a listed substance has been discovered. Valencia does not make any determination of the suitability of a student to serve in a clinical rotation or subjectively interpret any results; we merely determine whether a substance found through a drug screening is present on the affiliate s list of unacceptable substances and advise the affiliate of that fact. Positive results for any substance must have a viable medical explanation and the student shall have been prescribed treatment by a licensed health care professional. Where positive results do not have a medical explanation, students may be denied admission and may re-apply to the program at a later time. Incumbent students: Random drug testing will be required at the student s expense in the event of o A previous positive result o Suspicion of substance use/abuse o Affiliate policy change A positive result upon random drug testing will result in withdrawal from the clinical assignment with commensurate inability to meet the completion requirements of the program. At any point, all students may be required to provide fingerprinting through the college s contracted vendors.

5 AHA Basic Life Support for Healthcare Providers All students enrolled in programs in Valencia s Divisions of Nursing or Allied Health shall be required to obtain and maintain the American Heart Association Basic Life Support (BLS) for Health Care Providers certification. For the purpose of Valencia student clinical rotations, ONLY American Heart Association certification is acceptable per our hospital affiliates. For students required by their respective program to have advanced certification (ACLS and/or PALS), only American Heart Association certification is acceptable. Students will upload a copy of their current American Heart Association card to their Certified Background tracker. It is the student s responsibility to maintain all certifications required by the program in which he/she is enrolled and to present documentation of updated certifications during the duration of their enrollment. Health Care Provider (CPR) Classes Available Valencia College is an American Heart Association Training Site Offers certification and re-certification classes at least once a month on the West Campus. The fee includes the student manual. You may register online with a credit card at Sections are identified for Valencia degree students. You must have your V# to register in these special sections to obtain student pricing: o Certification $40.00 o Re-Certification of an unexpired AHA BLS card $20.00 For more information or to pay by check or cash, contact the Office of Continuing Education and Clinical Compliance Location: West Campus, HSB 200 Phone: or Other Student-Friendly American Heart Association Providers CPR for Citizens: (Rick McGarrity) For schedule, pricing and/or register for classes, call Provider accepts only cash or check, no credit cards All Care Health Services Present current Valencia I.D. To locate other approved American Heart Association providers, go to \\fs-shares.local.valenciacc.edu\shares\health sciences-common\west campus\division of health sciences\compliance\forms\cpr bls certification requirement.doc

6 FREQUENTLY ASKED QUESTIONS regarding documents that meet the requirements of your program. Refer to Student Instructions for Certified Profile Revised TRACKER REQUIREMENT WHAT IS ACCEPTABLE DOCUMENTATION? WHEN IS FORM REQUIRED? WHAT DO I DO WITH THE FORM? WHAT IF THE FORM IS NOT REQUIRED? Documentation of Physical Exam Valencia Health and Physical Form OR Provider Documentation including limitations with provider signature/date One time; physical must have been within the past year Upload this document to Documentation of Physical Exam requirement on your tracker TST (tuberculosis skin test); also known as PPD Valencia Health and Physical Form OR Provider Documentation with provider signature/date placed, date read, result Annually Upload this document to TST requirement on your tracker Chest X-Ray Results/Report Provider results/report Provide ONLY if you have had a positive TST/PPD. One time Upload this document to the Chest X-Ray Results/Report requirement on your tracker Respond N/A; do not leave blank or as no record attached. TB Screen Tuberculosis Screening sheet provided by Valencia Annually ONLY if you have had a positive TST/PPD and a subsequent negative chest x-ray ( CXR) Upload this document to the TB Screen requirement on your tracker Respond N/A; do not leave blank or as no record attached. MMR 1 and 2: Immunity to rubeola (measles) and rubella Rubella Valencia Health and Physical Form OR Provider Documentation with provider One time signature/date OR official titer results Upload dated documents to MMR 1, then MMR 2 requirements. If you have a titer for rubeola and rubella, attach documentation to both requirements on your tracker. Varicella 1 and 2 (Chicken Pox) Valencia Health and Physical Form OR Provider Documentation with provider signature verifying you had the One time disease OR official titer results. Vaccines at least one month apart. Upload this document to the Varicella 1 and 2 requirements on your tracker

7 FREQUENTLY ASKED QUESTIONS regarding documents that meet the requirements of your program. Refer to Student Instructions for Certified Profile Revised TRACKER REQUIREMENT ACCEPTABLE DOCUMENTATION? WHEN IS FORM REQUIRED? WHAT DO I DO WITH THE FORM? IF NOT REQUIRED? TD/Tetanus Diptheria It is advised by the CDC (2009) that you have at least one dose of Tdap (which includes pertussis) for adults aged 19 through 64 years. This is good for 10 years as well. Valencia Health and Physical Form OR Provider Documentation You must show dates for a tetanus immunization every ten (10) years. Upload this document to the Tetanus requirement on your tracker Hepatitis B Series is given to protect YOU from Hepatitis B infection. ONLY American Heart Association Basic Life Support for Healthcare Provider (CPR) You must hold a current (not expired) certification FIT Test N 95 FIT testing is done at Valencia during program orientations and upon annual renewal Seasonal Flu Vaccine Valencia Health and Physical Form OR Provider Documentation. Hepatitis B vaccine is given in three doses: Hepatitis #1, Hepatitis #2 one-two months later, Hepatitis #3 six months later to complete the series. American Heart Association Healthcare Provider certification card showing both sides of the card including the issue/renewal date and the AHA provider. Valencia FIT Test Certificate OR FIT certificate from employer. Must show size, type, date, and name/signature of provider Provider Documentation which includes date of administration Documentation must be provided to verify that you have had any or all of the three immunizations in the series. If you choose not to have the Hepatitis series, you must sign a declination (on Valencia Health and Physical form)and attach it to all three requirements. A valid card must be provided upon entry to the program and upon expiration of the card during the program Upon entry to program and annually per OSHA mandate During influenza season Upload this document on your tracker as follows: If you have documentation for the three shot series, upload documentation to each requirement: Hepatitis #1, Hepatitis #2 and #3. If you have just received Hepatitis #1, put N/A for Hepatitis #2 and #3. You will be notified when your 2nd Hepatitis is due; then Upload to this requirement. If you have a positive titer to Hepatitis, upload it to ALL 3 requirements. Upload this document to the AHA BLS requirement on your tracker Upload the FIT certificate to the FIT Test N95 requirement matching your size Upload to Seasonal Flu Requirement Respond N/A to the size that does not fit you; do not leave blank or as no record attached.

8 SEASONAL INFLUENZA VACCINE DECLINATION Influenza vaccine is strongly recommended for healthcare workers, not only to protect themselves, but also to reduce the chance of spreading influenza to patients, their families, and to the community. Influenza infection can lead to serious complications and can be fatal, especially in elderly or sick persons, including those who are hospitalized. In the U.S. approximately 200,000 people are hospitalized and 36,000 persons die from influenza each year. The influenza vaccine is highly effective in PREVENTING infection. Valencia Divisions of Nursing and Allied Health are committed to the health and well-being of students, faculty, and patients and we consider influenza vaccination a PATIENT SAFETY priority. PLEASE HELP PREVENT THE TRANSMISSION OF INFLUENZA BY RECEIVING THE ANNUAL INFLUENZA VACCINE. If you choose to decline the vaccination, please complete this form and upload it to your immunization tracker and/or provide it on demand in your clinical setting. PRINT NAME: First MI Last VALENCIA PROGRAM (circle one): Nursing Paramedic EMT CVT Respiratory Radiography Dental Hygiene Sonography Answer the following questions: 1. YES NO Have you ever had a severe allergic reaction to chicken eggs? 2. YES NO Have you previously had a severe reaction to an influenza vaccination OR other vaccinations? 3. YES NO Do you have an allergy to any preservatives used in vaccines? 4. YES NO Have you ever developed Guillian-Barre syndrome following influenza vaccination? DECLINATION OF VACCINE: I have read the above statement regarding seasonal influenza vaccine. I fully understand that my declination will necessitate my wearing a mask during the entire shift in some clinical settings as required by the facility. I am choosing not to take the vaccine for the following reason(s): Answered yes to the questions above (1-4) Dislike of needles Concern for side effects Don t think vaccines work Never get flu Fear of getting influenza from vaccine Other: Signature: Date: Rev. 1/20/2012

9 Valencia Community College Division of Health Sciences Tuberculosis Symptom Screening Sheet Form Revision Date: May 2010 FORM TO BE COMPLETED BY STUDENT Student Name (Print) VID # This form is required annually ONLY if the student has a positive TB skin test (TST or PPD) followed by a normal chest x-ray or has received BCG and has had a normal chest x-ray. PRINTED NAME: STUDENT SIGNATURE: DATE: Do you currently have, or have you had in the past two months, any of the following: SYMPTOM YES NO Productive cough Night sweats Shortness of breath Loss of appetite Unusual tireness Unintentional weight loss Fever Swollen or tender lymph nodes Please answer the following questions and comment on positive answers QUESTION YES NO DATE Have you ever been exposed to TB? If yes, when? Have you ever had a positive TB skin test? If yes, when? Have you ever taken BCG vaccine? If yes, when? Are you currently taking medication(s) for TB? Have you ever taken medication(s) for TB?

11 Page 1 Valencia College Divisions of Nursing and Allied Health HEALTH AND PHYSICAL FORM Revised: October 2012 TO BE COMPLETED BY STUDENT: Name: VID #: Street Address: DOB: City/State/Zip Phone #: Health Science Program: Circle your program AVS CVT Dental Hygiene EMT Generic Nursing Paramedic Radiography Respiratory Sonography MRI CT Polysomnography RN Refresher TO BE COMPLETED BY STUDENT'S HEALTH CARE PROVIDER: PHYSICAL EXAMINATION: indicate ability to perform standards described below LIMITATIONS: Mobility: Physical abilities sufficient to move from room to room and maneuver small spaces; move freely to observe and assess patients and perform emergency care to include full manual dexterity of upper extremities,including neck and shoulders, unrestricted movement of lower extremities, back, hips,in order to assist in all aspects of care. Ability to touch floor to remove environmental hazards and to include nursing procedures as applying restraints bladder catheterization and injections. Motor Skills: Gross and file motor abilities sufficient to provide safe and effective care Hearing: Auditory abilities sufficient to monitor and assess patient needs and to provide a safe environment Visual: Visual ability sufficient for observation and assessment necessary in the operation of equipment and care of patients Tactile: Tactile ability sufficient for patient assessment and operation of equipment Cognitive: abilities to include calculating medication dosages, interpreting and carrying out provider orders, read and comprehend course materials,patient care documents and facility policies and procedures PERSONAL HISTORY Describe any conditions (including allergies to substances normally found in a clinical setting) that could potentially impact the student's attendance and/or performance. if a student should present with any physical or cognitive limitation, each case will be reviewed on an individual basis. Reasonable accommodations will be made as determined by the Office for Students with Disabilities. HEALTHCARE PROVIDER SIGNATURE AND/OR STAMP Following the performance of a physical exam and utilizing history and immunization information provided to me by the student, I verify the above information to be true. Signature and/or Stamp of Healthcare Provider (MD,DO, PA, ARNP) Date: Provider Printed Name: Phone: \\fs-shares.local.valenciacc.edu\shares\health Sciences-Common\West Campus\Division of Health Sciences\Compliance\FORMS\RESTRICTED_WORKING COPIES\HEALTH AND PHYSICAL\Health and Physical_ xls

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